Provider Demographics
NPI:1265584858
Name:MINGER, KELLY J (OT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:MINGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 W 100 S
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-8204
Mailing Address - Country:US
Mailing Address - Phone:260-726-4020
Mailing Address - Fax:260-726-1805
Practice Address - Street 1:1756 W 100 S
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-8204
Practice Address - Country:US
Practice Address - Phone:260-726-4020
Practice Address - Fax:260-726-1805
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003410A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist